WebCataract surgery injury occurs in approximately 12% of cases. The most common complications were elevated intraocular pressure requiring initiation of pressure-lowering medications and development of visual field damage due to elevated intraocular pressure. Poorly documented cases were deemed more difficult to defend, whereas claims with aggressive intraocular manipulation by the cataract surgeon resulting in retinal detachment were more likely to result in poor final visual acuity and were more likely to go to a trial or settle. All variables significant at a 10% level in the univariate analyses were included in a multivariate proportional odds regression model. Hansson LJ, Larsson J. Vitrectomy for retained lens fragments in the vitreous after phacoemulsification. Ali N, Little BC. Claims data of all the identified claims based on coding were reviewed and further narrowed to include only those claims where there was a mention of a retained, dropped, or dislocated crystalline lens fragment with or without other comorbidities. Retained lens fragments can be successfully managed by the retina specialists in most cases. The complication of capsular tear and retained lens fragments was further aggravated by development of corneal wound dehiscence, corneal ulcer, and endophthalmitis. In contrast, among the 47 cases where referral to a specialist was earlier than 1 week, only 28% went on to a trial or settlement. For instance, indemnity payment by OMIC is 21% less than ophthalmic claims payment by the next largest insurer of ophthalmologists when settlement was required.97 Therefore, payment amount in this study using OMIC data would be on the lower side compared to the combined indemnity payment from all insured ophthalmologists. There appeared to be differences in legal outcomes depending on the state where the physician practiced, such that claims from Louisiana were most likely to be dismissed. Lu H, Jiang YR, Grabow HB. Therefore, medical malpractice added over $55 billion to the nations total healthcare costs both directly through malpractice claims and indirectly to avoid claims.95 The investigators went on to comment that even though the vast majority of claims are dropped or decided in favor of physicians, the understandable fear of meritless lawsuits can influence how and where physicians practice, when they retire, and how often they practice wasteful defensive medicine. Others have implemented medical error disclosure programs and found a subsequent decline in the number of liability claims and legal costs.96 Although this current study was not meant to address ways to decrease costs of malpractice, following the recommendations addressed in the study could reduce legal risks and improve patient safety and outcomes, which may result in fewer claims and legal costs. In the univariate analysis the P values for continuous variables were calculated based on nonparametric tests: Wilcoxon rank sum test for two groups (indemnity payment vs no indemnity payment) and Jonckheere-Terpstra trend test for multiple groups (trial vs settlement vs dismissed). For patients who have relatively good preoperative visual acuity, additional care should be taken during preoperative discussion and informed consent process and proper documentation should be performed as to the necessity of the surgery. CI, confidence interval; IOP, intraocular pressure; OR, odds ratio; SE, standard error. These items can be broadly separated into those pertaining to (1) the physician, (2) the patient, (3) preoperative, intraoperative, and postoperative clinical data, and (4) the litigation. Medical professional liability claims and premiums. Seven hundred medicolegal cases in ophthalmology. The retina specialist confirmed that the IOL was well positioned without vitreous in the anterior segment. For the current study, the claims were categorized into those that went on to a trial, settlement, or dismissal, and those with or without indemnity payment. In all cases, retinal detachment occurred, 5 after the cataract surgery and 2 after pars plana vitrectomy and lensectomy by retinal specialists. Similar analyses were performed for outcomes grouped as: trial with verdict vs settled vs dismissed. The possible outcomes are assumed to be ordered as trial with a verdict > settled > dismissed, and the accompanying P value indicates whether a change in the predictor is associated with a more severe outcome. Over 3 million cataract surgeries are performed annually in the United States.18 Given the frequency of this procedure, perhaps it is not surprising that cataract surgery is the single most frequently named procedure in malpractice actions against ophthalmologists.1315 An uncommon but potentially devastating complication of cataract surgery that can affect both the anterior segment and the posterior segment surgeons is posterior dislocation or retention of lens fragments during cataract surgery. If you and your attorney manage to navigate the many procedural requirements, find an expert witness and demonstrate to the other side that you probably have a winning case, the final wrangling in the case will be over just what kind of damages resulted from your ophthalmologist's negligence, i.e. You will probably need to find a medical expert witness who has adequate knowledge of (or experience with) performing cataract surgeries (usually a practicing ophthalmologist) to testify as to what the proper standard of care was, and then to show that not only did your ophthalmologist fall short of that standard, but that you were also injured because of that sub-standard care. The https:// ensures that you are connecting to the One month later, she developed a tractional retinal detachment, ciliochoroidal detachment, and hypotony. In one case, the surgical technician failed to securely attach the cystotome to the needle, and the cystotome shot off during injection of the viscoelastic material. The vitrectomy probe was inserted in an attempt to aspirate the lens, but the lens could not be aspirated to be removed. The median payment was $90,000. Of the 12 claims that went on to a trial, there were 5 claims from Illinois, 2 claims from Arizona, and 1 claim each from Colorado, Florida, Kentucky, Rhode Island, and Texas. The most common risks are: Although you may have experienced an unexpected outcome, even a severe injury, that does not mean medical malpractice is necessarily the cause. Acknowledgments: J.K. would like to thank Dr Harry Flynn Jr for critical reading of the manuscript, his mentorship, and getting her interested in the topic of retained lens fragments. Whereas good final visual acuity did not prevent indemnity payment, 23 of 32 claims (72%) with indemnity payment had final visual acuity of 20/200 or worse. In 11 eyes, the operated eye was the better eye. Colyer MH, Berinstein DM, Khan NJ, et al. Available at: Slora EJ, Gonzales ML. The remaining 9 cases (10%) were left aphakic by the cataract surgeon. Duty to treat means that a doctor-patient relationship must be established prior to the alleged negligent act. Rofagha S, Bhisitkul RB. Physicians with higher frequency of patient complaints may indicate less attention to interpersonal or technical aspects of patient care.2,8691 Interestingly, a physicians credentials, such as board certification, ranking of medical school attended, and foreign medical school graduate vs US graduate, did not have a significant impact on whether a physician was more likely to get sued or not.4 However, various studies indicate that the risk of being sued appears to be related to patients dissatisfaction, which may be related to their physicians ability to establish rapport, provide access, administer care consistent with expectations, and communicate effectively and in a timely fashion.4, 8791 Other physicians who subsequently manage the patient may also have a role in the patients decision to bring a claim.91. The mean payment was $117,688, and the median payment was $90,000. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. Also, settlement should not be considered admission of malpractice, since some physicians, patients, and insurance carriers may elect to settle in order to avoid prolonged litigation or stress or to minimize legal expenses. Many are related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and However, there is no prospective randomized clinical trial to guide which cases should be referred for surgical management. The top 5 states in terms of overall frequency of claims in rank order were Illinois (18 cases), Texas (16 cases), California (11 cases), Florida (10 cases), and Louisiana (10 cases). Medical malpractice cases present a complex interaction between medical and legal issues, and it typically takes an experienced medical malpractice attorney working alongside a well-qualified expert witness to present the best case. During the surgery, the new lens was too small due to a Therefore, ways to improve risk management and enhance patient outcome would include optimal management of intraocular pressure and inflammation, avoidance of aggressive maneuvers intraoperatively that may result in retinal detachment, close follow-up and sufficient documentation, and timely referral to a subspecialist when necessary. Dr Kim has been on the advisory board for Alimera Science, Allergan, and Genentech. In the multivariate analysis, only the amount of change between preoperative and final visual acuity ( logMAR visual acuity) was found to be statistically significant in predicting more severe legal outcome. Malpractice risk according to physician specialty. Moore JK, Scott IU, Flynn HW, Jr, et al. They found that the claims frequency for ophthalmology was slightly lower than the average for all specialties and was in between nephrology and diagnostic radiology. If observation is considered, close follow-up is recommended for timely detection of increased intraocular pressure, cystoid macular edema, or retinal detachment. Missouri Medical Malpractice Lawyer If you have suffered as a result of medical malpractice, contact our legal team right away. Transactions of the American Ophthalmological Society, http://www.amaassn.org/ama1/pub/upload/mm/363/prp-201001-claim-freq.pdf, http://www.omic.com/about/financial_info/members_rpt.cfm, MVR blade to impale the fragment that landed on optic nerve, Duration of claim opening to closing (months), Duration between surgery and claim occurring (months), Duration of claim opening to closing (Months). Kageyama T, Ayaki M, Ogasawara M, Asahiro C, Yaguchi S. Results of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens fragments. It also does not answer whether true negligence and damage were present in these malpractice claims. Yazici AT, Kaya V, Bozkurt E, Imamoglu S, Yilmaz OF. In addition to corneal edema, inflammation from the lens material can result in elevated intraocular pressure that is significant enough to require pressure-lowering medication or development of glaucoma and potential visual field loss that require additional surgical intervention. The third claim alleged decreased vision following negligent vitrectomy surgery to manage retained lens fragment. Follow Posted 4 years ago, 24 users are following. The doctor used a technical lens for my right eye and a standard lens for the left one. Learn how we can help. Gender of the physician was not found to be a significant predictor of indemnity payment of the claims outcomes (Tables 6 and and77). National costs of the medical liability system. The possible outcomes are assumed to be ordered: Trial with a verdict > Settled > Dismissed and the accompanying P value indicates whether a change in the predictor is associated with a more severe outcome. However, these numbers may reflect the states in which OMIC has a major presence, since these are also states in which OMIC has the highest number of insured ophthalmologists. Her preoperative visual acuity was 20/25 in the right eye and 20/60 in the left eye, which fell to 20/400 with glare testing. The documentation includes informed consent, office examination notes, operative notes, any conversation with the patient before or after the cataract surgery, as well as any discussions with a specialist. Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule. For those claims with greater than 2 logMAR worsening in visual acuity, 62% resulted in an indemnity payment averaging $158,500. An official website of the United States government. In another study with anesthesiologists, approximately 40% of the claims did not involve substandard care but 42% of these claims ended with an indemnity payment.81, Therefore, it is difficult to clearly predict which physicians will get sued or what the final outcome of the malpractice suit will be. [tdc_zone type=tdc_content][vc_row][vc_column][td_block_trending_now limit=3][/vc_column][/vc_row][vc_row tdc_css=eyJhbGwiOnsiYm9yZGVyLXRvcC13aWR0aCI6IjEiLCJib3JkZXItY29sb3IiOiIjZTZlNmU2In19][vc_column width=2/3][td_block_slide sort=featured limit=3][td_block_2 border_top=no_border_top category_id= limit=6 td_ajax_filter_type=td_category_ids_filter ajax_pagination=next_prev sort=random_posts custom_title=SEA MOSS RECIPES][td_block_1 border_top=no_border_top category_id= sort=random_posts custom_title=SEA MOSS BEAUTY][td_block_ad_box spot_id=custom_ad_1][td_block_15 category_id= limit=8 sort=random_posts custom_title=SEA MOSS HEALTH BENEFITS][/vc_column][vc_column width=1/3][td_block_social_counter custom_title=STAY CONNECTED facebook=tagDiv twitter=tagdivofficial youtube=tagdiv border_top=no_border_top][td_block_9 custom_title=LIFESTYLE border_top=no_border_top category_id= ajax_pagination=next_prev sort=random_posts][td_block_ad_box spot_id=sidebar][td_block_2 sort=random_posts limit=3 category_id= custom_title=SEA MOSS BUSINESS][td_block_title][td_block_10 limit=3 custom_title= border_top=no_border_top tdc_css=eyJhbGwiOnsibWFyZ2luLXRvcCI6Ii0yMCJ9fQ==][/vc_column][/vc_row][/tdc_zone], Designed by Elegant Themes | Powered by WordPress. WebIt was discovered that a 23-power lens was inserted in the left eye, instead of the intended 20-power lens. The mean age was 69 years (range, 4090 years). Pars plana vitrectomy for the management of retained lens material after cataract surgery. Later records indicate that the patient complained of blurry vision from the presence of a vitreous strand. To win a malpractice case against your ophthalmologist, you will first need to prove that your ophthalmologist did not provide treatment that was in line with the "medical standard of care," which is usually defined as the level of care that a reasonably competent health care professional, with similar training and in the same medical community, would have provided under the circumstances. Early vitrectomy was considered to be between days 3 and 7 after the cataract surgery in their study. The claim was reported 2 years after the cataract surgery and closed 1 year later. Claims that settled during the trial or prior to the start date of the trial were included in the settlement group. Both of these were defined as glaucoma, and there were a total of 31 cases. You should consult with an attorney in your state as soon as possible. Time limitations apply so be aware of them. Check Avvo for a listing of atto Whereas indemnity payment is usually associated with all settled claims, claims that go on to a trial may or may not result in an indemnity payment, depending on the verdict. The allegations for the claims associated with cataract surgery complicated by retained lens fragments are listed in Table 4.
Ball Python Genetic Calculator,
Texas Property Code Tenants In Common,
Porgy Size Limit Florida,
Mobile Homes For Sale In Sandalwood Park, Venice Florida,
Articles C